1. Home>
2. Specialties>
3. General Medicine>
4. Summary and Comment

Renal Replacement Therapy in Critically Ill Patients with Acute Kidney Injury

In this large study, receipt of dialysis six times weekly was not better than three times weekly.

In relatively small studies in which more-intensive and less-intensive dialysis regimens were compared in critically ill patients with acute renal failure, results have been mixed. In a large multicenter trial, conducted at U.S. veterans’ hospitals, researchers have again addressed this issue.

The study involved 1124 critically ill adults who had acute kidney injury consistent with acute tubular necrosis, plus either sepsis or failure of another organ system. Patients were randomized to receive intermittent hemodialysis either six times weekly (intensive strategy) or three times weekly (less-intensive strategy); during intervals of hemodynamic instability, patients in both groups received continuous venovenous hemodiafiltration or sustained low-efficiency dialysis instead of standard hemodialysis.

At 60 days, mortality was similar in the intensive and less-intensive groups (54% and 52%). In addition, no significant differences were noted between groups in the rate of kidney function recovery or in the probability of being discharged home without need for dialysis.

Comment: In this study, an intensive renal-replacement regimen was no better than a less-intensive regimen in critically ill patients with acute kidney injury. In contrast, daily hemodialysis lowered mortality compared with alternate-day dialysis in another widely quoted study (JW Feb 15 2002). Why are the study outcomes divergent? The current authors’ explanation is that the previous study’s low-intensity regimen delivered a suboptimal "dialysis dose" per session, thus magnifying the difference between the more-intensive and less-intensive regimens.

— Allan S. Brett, MD

Published in Journal Watch General Medicine July 2, 2008

Citation(s):

The VA/NIH Acute Renal Failure Trial Network. Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med 2008 Jul 3; 359:7.

• Original article (Subscription may be required)
• Medline abstract (Free)